Efficacy of Disease-Modifying Drugs for Multiple Sclerosis May Decrease With Age

A regression model showed that efficacy of DMTs significantly decreased until age 53, after which disease progression is not affected by DMTs.

The following article is part of conference coverage from the 2018 American Academy of Neurology Annual Meeting in Los Angeles, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2018.

LOS ANGELES – The efficacy of immunomodulatory disease-modifying therapies (DMT) for multiple sclerosis (MS) significantly declines with advancing age, emphasizing the need for early, efficacious treatment in patients with MS. Data from the meta-analysis from which these findings were elicited were presented at the 2018 American Academy of Neurology (AAN) Annual Meeting, April 21-27 in Los Angeles.

A team of investigators led by Ann Marie Weideman, MS, of the National Institute of Neurological Disorders and Stroke and the National Institute of Health, conducted a meta-analysis of 38 randomized, blinded clinical trials of patients with MS (N=28,000) in which Expanded Disability Status Scale (EDSS) scores on disability progression were reported. A weighted linear regression model was used to classify FDA-approved drugs for MS as low or high efficacy, with possible interactions for age, efficacy classification, and baseline EDSS accounted for.

The investigators reported that the model predicted a strong decline in drug efficacy until age 53 (R2 = 0.6757; P =6.39e-09), after which there was no predicted benefit of receiving DMT. Notably, drugs deemed to have high efficacy were more beneficial in patients younger than 40.5 years vs those classified as low efficacy.

The investigators noted that the model is based on regressions of disability progression in average patients taking an average DMT and therefore may not be relevant to all patients.

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They concluded that “progression can be reduced by administering high-efficacy therapy during early stages of the disease,” a statement that is in line with the AAN’s recently published practice guidelines on DMTs in MS.

Disclosures: The study was supported by the National Institute of Neurological Disorders and Stroke and the National Institute of Health.